Provider Demographics
NPI:1386701787
Name:ISLAND VIEW GASTROENTEROLOGY ASSOC.
Entity type:Organization
Organization Name:ISLAND VIEW GASTROENTEROLOGY ASSOC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:IZQUIERDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-641-6525
Mailing Address - Street 1:168 N BRENT ST STE 404
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2824
Mailing Address - Country:US
Mailing Address - Phone:805-641-6525
Mailing Address - Fax:805-641-6530
Practice Address - Street 1:168 N BRENT ST STE 404
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-641-6525
Practice Address - Fax:805-641-6530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1386701787OtherMANAGER
CAWG62357CMedicaid
CAWPA18127AMedicaid
CA1386701787Medicaid
CAWG25356BMedicaid
CAWG83685AMedicaid
CAWA78582AMedicaid
CAWG232764BMedicaid
CA1386701787OtherNPI